Benefits and Drawbacks of Proton-Pump Inhibitors as a Protective Agent for Aspirin Users in Long-Term Care and Geriatrics - A Systematic Review
Journal Title: Journal of Quality in Health Care & Economics (JQHE) - Year 2024, Vol 7, Issue 5
Abstract
Background: The potential benefits and drawbacks of Proton-Pump Inhibitors (PPIs) for older adults who take lower doses of aspirin over an extended period remain uncertain and poorly protected. It is crucially important to understand if PPI shall be efficient for those using aspirin from the risk of gastrointestinal bleeding (GIB) in either short or long-term care. Objective: to review and examine the benefits and drawbacks of proton-pump inhibitors (PPIs) as a protected agent in longterm care and geriatrics, particularly for low-dose aspirin users, providing practical insights for clinicians. Our findings have practical implications for clinicians, highlighting the need to consider the long-term use of PPIs to optimise patient outcomes. Care. Methods: The review adheres to PRISMA guidelines, incorporating studies investigating PPIs' efficacy and safety in elderly patients. Systematic searches were conducted using PubMed, Google Scholar, NCBI, and Cochrane Reviews for the sources associated with the merits OR benefits AND demerits of PPI AND users of aspirin dose (GI bleeding in particular). We included studies without known pre-existing cardiovascular disease, with at least 1,000 participants for RCTs, over 100 for observational studies, and a follow-up period of 12 months. Data extraction focused on study characteristics such as demographics, PPI dosage, clinical outcomes, and adverse effects. Due to the heterogeneity of study designs and outcomes, a narrative synthesis was performed to ensure a comprehensive review. Main Results: Of the 3123 studies, only 6 were included in the full review. As identified in the review, PPIs have lowered the risk of uncomplicated peptic ulcers in elderly aspirin/non-steroidal anti-inflammatory medication users. Conclusion: Proton Pump Inhibitors (PPIs) effectively prevent gastrointestinal complications in elderly patients using NSAIDs or aspirin, but their long-term use requires careful consideration to optimise patient outcomes. Balancing symptom management and risk mitigation is essential, as is following evidence-based guidelines for safe and effective therapy. Limitations of current RCTs highlight the need for further research, particularly involving non-communicating long-term care patients. Policy implications emphasise using PPIs with NSAIDs and aspirin in symptomatic elderly individuals and caution in the long-term use of high-dose PPIs.
Authors and Affiliations
Omer ME*, Al Hamad HK, Abdulwahab Al-Husami MA, Taha Nemeri OB and Mousnad MA
Keywords
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- EP ID EP758786
- DOI 10.23880/jqhe-16000403
- Views 43
- Downloads 0
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